Does community HIV combination prevention (HPTN 071 (PopART)) impact healthcare inequity?

Abstract Background This research explores the impact of the HIV Prevention Trials Network (HPTN) 071 combination prevention (PopART) trial on horizontal inequity in Zambia and South Africa. Evidence suggests there is often inequality in healthcare utilisation in relation to socioeconomic characteristics, such as wealth. This paper is the first to address such distributional outcomes and inequities in a randomised trial setting. Methods We utilise horizontal inequity as a key performance metric to make value judgements with regards to the distribution of healthcare utilisation in a health system. Additionally, we supplement this index by estimating the impact of PopART on inequality in healthcare utilisation and HIV prevalence, estimating concentration curves and indices. Results We find a pro-rich inequity in healthcare utilisation, as ranked by wealth, before and after the trial is implemented. Pro-rich implies, for example, the 20% poorest make up less than 20% of healthcare utilisation. This suggests the trial enabled the wealthier subset of the population to take better advantage of accessing healthcare. Conclusions Given the high prevalence of HIV in lower-income households in Zambia and South Africa, these results strengthen the case for interventions tailored to informing poorer households about the benefits of prevention and after-care. Key messages • The PopART trial demonstrates as with any intervention, there is a risk of exacerbating an underlying inequity. Policies directed at these problems specifically may help alleviate such burdens. • This paper shows one example of a distributional imbalance in the HIV population. Given the absence of work on RCT interventions, the findings may also be used to inform future trial design.

During COVID-19 pandemic, health and social condition of frail elderly got worse at worldwide level. This aggravation was due both to isolation and higher mortality rate for COVID-19, influenced by the widespread condition of comorbidity in this segment of population. The progressive change of needs in this target weren't matched with a prompt and adequate response, which could guarantee the taking charge of frail elderly. Personal budget is a tool for integrating public health, social assistance and family efforts on the international scene. In the Italian context, it is emerging as means to program and coordinate economic and professional, institutional, and personal resources, finalising them to provide a personalised pathway. Research aims to value the contribution of personal budget association to effectiveness and efficacy of personalised pathway for frail elderlies in early supported discharges.
A research-intervention approach was done. Personal budget was applied to a significant sample of cases of personalised pathways for frail elderly in supported discharge in the Local Health District of Teramo. The study compared used resources and obtained health outcomes between the sample and a control group. The application of the personal budget permits the immediate maximisation of resources use and the quantification of the deviation between the available and the needed resources for provision of personalised pathway. Moreover, this tool supported the planning of services, the integration of health and social actions, the monitoring of adherence to planned programmes and the application of corrective mechanisms, if these are necessary, improving the health outcomes. Personal budget contributes to increase the integrated and continued taking charge of frail elderly in supported discharges in the short-medium term. Globally, this tool could be an organisational and economic answer for responding in a sustainable way to international increasing of life expectancy. Key messages: Personal budget manages and controls both health and social activities and resources. Personal budget supports the establishment of an integrated and continuous taking charge system of the frail elderly.

Background:
This research explores the impact of the HIV Prevention Trials Network (HPTN) 071 combination prevention (PopART) trial on horizontal inequity in Zambia and South Africa. Evidence suggests there is often inequality in healthcare utilisation in relation to socioeconomic characteristics, such as wealth. This paper is the first to address such distributional outcomes and inequities in a randomised trial setting.

Methods:
We utilise horizontal inequity as a key performance metric to make value judgements with regards to the distribution of healthcare utilisation in a health system. Additionally, we supplement this index by estimating the impact of PopART on inequality in healthcare utilisation and HIV prevalence, estimating concentration curves and indices.

Results:
We find a pro-rich inequity in healthcare utilisation, as ranked by wealth, before and after the trial is implemented. Pro-rich implies, for example, the 20% poorest make up less than 20% of healthcare utilisation. This suggests the trial enabled the wealthier subset of the population to take better advantage of accessing healthcare.

Conclusions:
Given the high prevalence of HIV in lower-income households in Zambia and South Africa, these results strengthen the case for interventions tailored to informing poorer households about the benefits of prevention and after-care.

Key messages:
The PopART trial demonstrates as with any intervention, there is a risk of exacerbating an underlying inequity. Policies directed at these problems specifically may help alleviate such burdens. This paper shows one example of a distributional imbalance in the HIV population. Given the absence of work on RCT interventions, the findings may also be used to inform future trial design.
iii416 European Journal of Public Health, Volume 32 Supplement 3, 2022